Maternity Nursing: cram pack

Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.

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1Formulas and methods

Maternity & obstetric nursing

Method

  1. Place the woman in time: weeks of pregnancy, stage of labour or day after birth, and decide what is normal at that point.
  2. Look for the patient in danger: the mother, the fetus or the newborn, or more than one of them.
  3. Link the finding to its cause: VEAL CHOP for decelerations, the four Ts for bleeding, BUBBLE-HE after birth.
  4. Choose the action that improves blood flow and oxygen first (side-lying, stopping oxytocin, fundal massage), then escalate.

Dosage calculations

Dose from strength
volume = dose / strength
Weight-based dose
dose = mg/kg × body weight
Tablets
number = dose / tablet strength
Units
1 g = 1000 mg, 1 mg = 1000 mcg

Method

  1. Convert the ordered dose and the stock strength to the same unit.
  2. Use desired over have times quantity: (D/H) × Q.
  3. For weight-based doses, multiply by the weight in kg first, then divide the daily dose by the number of doses.
  4. Estimate first and check that the answer is reasonable.

IV infusion rates

Pump rate
mL/h = volume (mL)/time (h)
Drip rate
drops/min = volume (mL) × drop factor / time (min)
Infusion time
time (h) = volume (mL)/rate (mL/h)

Method

  1. Pump rate in mL/h: volume divided by time in hours.
  2. Drip rate in drops/min: volume × drop factor divided by time in minutes.
  3. For time remaining: volume left divided by the rate.
  4. Round as the question or the equipment requires.

2Practice problems

1.Maternity & obstetric nursingMedium

A woman 1 day after birth has a blood pressure of 150/96 mmHg and a headache. She had normal blood pressures in pregnancy. What should the nurse do?

  1. AEncourage her to walk to lower her blood pressure
  2. BReport it and assess for postpartum pre-eclampsia
  3. CGive paracetamol (acetaminophen) and ignore the blood pressure
  4. DReassure her that this is normal after birth
2.Maternity & obstetric nursingHard

An ultrasound at 30 weeks shows polyhydramnios and no visible fetal stomach bubble. Which fetal condition should be considered?

  1. AFetal growth from maternal diabetes only
  2. BRenal agenesis
  3. COesophageal atresia
  4. DPost-term pregnancy
3.Dosage calculationsMedium
024681010 mL

A child weighing 40 kg is prescribed 3 mg/kg of a drug. The stock solution contains 25 mg/mL. Draw up the dose: what volume V do you give?

40 kg3 mg/kg25 mg/mL
V = mL
4.Dosage calculationsHard
40 mg/1 mLV = ? mL

A child weighing 8 kg is prescribed 10 mg/kg per dose of an oral suspension that contains 40 mg in 1 mL. What volume V do you give?

8 kg10 mg/kg40 mg/1 mL
V = mL
5.IV infusion ratesMedium
V = ?20 gtt/mL35 gtt/min12 h

A drip runs at 35 gtt/min through a set of 20 gtt/mL. How many millilitres V does the patient receive in 12 hours?

35 gtt/min20 gtt/mL12 h
V = mL
6.IV infusion ratesHard
2 g250 mL? mL/h1 mg/min

A bag contains 2 g of a drug in 250 mL. The order is 1 mg per minute. At what rate R do you set the pump, in mL/h?

2 g/250 mL1 mg/min
R = mL/h

3Solutions

1.Maternity & obstetric nursing

Answer: B · Report it and assess for postpartum pre-eclampsia

Why this is the answer

New hypertension with a headache after birth can be postpartum pre-eclampsia, even with normal readings in pregnancy. The nurse reports it, checks urine protein and symptoms and follows the protocol.

Answer

B · Report it and assess for postpartum pre-eclampsia
2.Maternity & obstetric nursing

Answer: C · Oesophageal atresia

Why this is the answer

If the fetus cannot swallow, as in oesophageal atresia, amniotic fluid builds up and the stomach is not seen. Renal agenesis causes the opposite, severe oligohydramnios.

Answer

C · Oesophageal atresia
3.Dosage calculations

Answer: V = 4.8 mL

Drawing up a dose: volume = (prescribed dose/stock strength) × stock volume. Convert to the same units first, then check that the volume fits the syringe and lands on one of its graduations.

Dose from body weight

D = 3·40 = 120 mg

Volume

V = 120/25 = 4.8 mL

On the syringe

On this 10 mL syringe every small line is 0.2 mL.

Answer

V = 4.8 mL
4.Dosage calculations

Answer: V = 2 mL

Dose calculation: the amount to give equals what is prescribed divided by what you have, times the quantity it comes in: amount = (desired dose/stock strength) × stock volume. Always keep the units the same (convert g to mg, mg to mcg first) and check that the answer is sensible.

Dose from weight

10·8 = 80 mg

Volume

V = (80/40)·1 = 2 mL

Answer

V = 2 mL
5.IV infusion rates

Answer: V = 1260 mL

Infusion rates: a pump is set in mL/h = volume/time in hours. A gravity drip is counted in drops per minute: gtt/min = volume (mL) × drop factor (gtt/mL)/time (min). The drop factor is printed on the tubing package: macrodrip sets deliver 10, 15 or 20 gtt/mL (blood sets often 10 gtt/mL in the US, 15 in the UK) and microdrip sets 60 gtt/mL. Always use the drop factor the question or package gives.

Rate in mL/h

35·60/20 = 105 mL/h

Volume

V = 105·12 = 1260 mL

Answer

V = 1260 mL
6.IV infusion rates

Answer: R = 7.5 mL/h

Dose-based infusions: concentration = amount of drug in the bag/bag volume. Pump rate (mL/h) = dose per hour/concentration, and dose per hour = mL/h × concentration. Convert per-minute doses to per-hour (× 60) and keep the mass units the same (1 g = 1000 mg, 1 mg = 1000 mcg).

Concentration

2000 mg/250 mL = 8 mg/mL

Dose per hour

1·60 = 60 mg/h

Pump rate

R = 60/8 = 7.5 mL/h

Answer

R = 7.5 mL/h

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